AccountId: 011433970860
ContactId: 9b9888d1-ac02-49bc-beeb-5e99cf512b5d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1288770 ms
Total Talk Time (AGENT): 412770 ms
Total Talk Time (CUSTOMER): 538211 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/9b9888d1-ac02-49bc-beeb-5e99cf512b5d_20250310T16:55_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I um I have uh questions about several bills, um, just to make sure that they have come through you guys before I pay them um I can give you whatever you need to look those up. Do you need um a group number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let me have your name and a callback number just in case we get disconnected first.
[CUSTOMER][POSITIVE] Sure, perfect. [PII], I mean, [PII], I was jumping to the next thing [PII].
[AGENT][NEUTRAL] OK, and may I have the policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, um.
[CUSTOMER][NEUTRAL] Mm, is that like the in hospitals or out hospital, is that that number?
[AGENT][NEUTRAL] Yeah, yeah, the certificate number, just the first part.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, 02549425 ML and there's either 7 or 8 depending on which one I'm we're doing.
[AGENT][NEUTRAL] Hm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And may I have your date of birth for security?
[CUSTOMER][NEUTRAL] Yes, [PII] and this is regarding my daughter [PII] and I can give you any information about her.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the mailing address on file for verification?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And let's see and.
[AGENT][NEUTRAL] Is she available?
[CUSTOMER][NEUTRAL] No, she, um she lives uh in another state.
[AGENT][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] What is the date of service for the claim?
[CUSTOMER][NEUTRAL] Um, well, there's several, um, there's several bills I would just wanna check, um.
[CUSTOMER][NEUTRAL] Starting with uh first one would be.
[CUSTOMER][NEUTRAL] I think [PII], um, yeah, [PII] probably.
[CUSTOMER][NEUTRAL] And then going through [PII] I think.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, I'm gonna need one by one because I need to check and see if we received that claim. So it, it will be the same as looking at the bills. You need to look at the date of service and the amount of the, the bill, and I can check in my system to see if I received that bill or that claim. So the first one is [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Well, now, let's start with, uh, I just got the one on the top [PII]:25.
[AGENT][NEUTRAL] 9:25. OK. All right, let's see.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] [PII] and this was for what facility?
[CUSTOMER][NEUTRAL] What facility? I'm sorry because you're breaking up a teeny bit, so that's, I'm just making sure, um, this is for West Kendall Baptist Hospital.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you know if this is the doctor's charges or is it the hospital, the ER?
[CUSTOMER][NEUTRAL] Um, I believe.
[CUSTOMER][NEUTRAL] I believe the ER.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] I'm not really sure they just gave one lump sum so on this one.
[AGENT][NEUTRAL] OK. OK. Well, I can tell you what we received for them. OK. All right, so I'm waiting on the paperwork. Bear with me.
[AGENT][NEUTRAL] OK, so we did receive a claim for West Kendall Baptist.
[AGENT][NEUTRAL] And um the total charge of the bill was 19,691. I don't know if that's the one you're looking at.
[CUSTOMER][POSITIVE] Yes, that is correct. That's what I'm looking at.
[AGENT][NEUTRAL] OK, and we pay the $500 maximum benefit of the policy for that date of service.
[CUSTOMER][NEUTRAL] OK, so, and, um, so I would just because I, I have never received another bill and this bill was from, oh goodness, [PII], so I just wanted to, um, should I just wait for the bill to see the deduction or.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm, you can always call to see if it's been applied, but yeah, we did process and pay that bill.
[CUSTOMER][NEUTRAL] OK, I'm just gonna write as we go APL did process.
[CUSTOMER][NEUTRAL] And pay $500.
[CUSTOMER][NEUTRAL] And do you have a date on that?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And is there um just so I can get it so I don't have to call back and do you have a check number or a number that that would.
[CUSTOMER][NEUTRAL] Could I could use with that if I needed to?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And check number is 2025547.
[CUSTOMER][NEUTRAL] 2025547
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you so much. OK. Next one is um.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Let's see from.
[CUSTOMER][NEUTRAL] The date is [PII].
[CUSTOMER][NEUTRAL] Um, [PII] and that is the, the billing is emergency physicians of Country Walk.
[AGENT][NEUTRAL] So it's the same date of service, just a different doctor?
[CUSTOMER][NEUTRAL] Correct. Different, um, yeah, I think that was the ambulance.
[AGENT][NEUTRAL] OK, the, the only, the only thing I can tell you at this moment is that the only claim we have is for West Kindle for that date of service.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, so they didn't even though so because I called APL back whenever I got, let's see, I don't know when the date was that I called, but and you, you do cover some of ambulance services.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can check the benefits. Let me check one moment.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage and let's see.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, ambulance is part of the benefits.
[CUSTOMER][NEUTRAL] And OK, OK, so I called months ago on that and they still have not put that through with that insurance, so I'm gonna have to call them back on that one alright um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this is from 9252. This is for um.
[CUSTOMER][NEUTRAL] Mm, this is for MRI to tomography, head or brain without contrast. Is that an MRI or is that um CAT scan? Probably a CAT scan maybe.
[AGENT][NEUTRAL] Probably a CAT scan. Uh, what code does it have?
[CUSTOMER][NEUTRAL] And the code is like the number right before is 7, there's two codes 74177 and 70,450.
[AGENT][NEUTRAL] OK, so this one is a CT scan.
[AGENT][NEUTRAL] Um, the first one is the CT scan.
[AGENT][NEUTRAL] OK. And I guess um you're looking at the radiology bill?
[CUSTOMER][NEUTRAL] Um, so this is radiology, yes, this is, yes.
[AGENT][NEUTRAL] Mhm. Yeah, we have not received that bill.
[CUSTOMER][NEUTRAL] But you, that's
[CUSTOMER][NEUTRAL] That date is for [PII] too, so you said nothing else was on. OK, so, um, I'll call back. I called them in January and they still have not submitted it to APL. You do cover is my does will you cover any of a CAT scan or no?
[AGENT][NEUTRAL] Yeah, we have not. Mm.
[AGENT][NEUTRAL] It is part of the diagnostic testing benefit.
[CUSTOMER][NEUTRAL] OK, so it's a possibility right so I'll call them back, um.
[CUSTOMER][NEGATIVE] So that has not gone through either. Oh my goodness, and then they'll send the bills and expect you to pay them immediately. It's unbelievable, um.
[CUSTOMER][NEGATIVE] APL has not gotten anything.
[CUSTOMER][NEUTRAL] OK, next one is from equipped for life and the date is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] How much is that one for?
[CUSTOMER][NEUTRAL] That one's for 2 1336.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Have several claims for that day. Um, one moment.
[AGENT][NEUTRAL] And you said it was equipped for, OK, so this is not in.
[AGENT][NEUTRAL] For the next one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] like.
[AGENT][NEUTRAL] Alright just hold let me try this one.
[AGENT][NEGATIVE] No, I don't see one that says to quit for life.
[CUSTOMER][NEUTRAL] OK, um, all right, then I'll.
[CUSTOMER][NEGATIVE] Because they said they were going, I called them in December actually in November and December and they still not put it through. I guess people don't want their money, um.
[CUSTOMER][NEUTRAL] So nothing, so when you, if for instance, if you're, if something is sent to you and it's not um covered by the insurance, then you do make a note of it that was sent to you and it just isn't covered, is that correct?
[AGENT][NEUTRAL] We'll send the explanation of benefits and the reason why it was not covered um and then um so um we sent two copies. One is for the insured, the other one is for the provider.
[CUSTOMER][NEUTRAL] OK, so you would have it in your notes if you had gotten anything for a lip for Life, correct?
[AGENT][NEUTRAL] Not in the notes, but I will have an explanation of benefits, which I didn't find one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I see what you're saying. I just wanted to verify like when they come back and say, oh we sent that, well then, you know, of course I'm in the middle, but if I believe you guys over them honestly because I.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Well.
[AGENT][NEUTRAL] Yeah, uh, the other thing you can do is ask them, are you billing with a different name instead of this one just in case, um, if they use any other names to bill, um, you need to know so we know and we can search for it, but I didn't see that amount either, so, um, yeah, but you can check with them just to make sure. Mhm.
[CUSTOMER][NEUTRAL] OK, you look for both. OK, OK, perfect, um, let me just write a note so I don't forget on all these, um.
[AGENT][NEUTRAL] Yeah, because sometimes they will go ahead and charge with a different company name you never know.
[AGENT][NEUTRAL] It's a billing office so sometimes they use a different billing office.
[CUSTOMER][NEUTRAL] OK, but
[CUSTOMER][NEUTRAL] But you don't see the amount so that would be I.
[AGENT][NEUTRAL] But I don't see the amount.
[CUSTOMER][NEUTRAL] All right, um, then there's one for [PII] and it's, uh, Greenville County EMS or Patewood Hospital.
[CUSTOMER][NEUTRAL] Um, Prisma, it's for 837 62 is the amount.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And that was um
[CUSTOMER][NEUTRAL] An emergency room.
[AGENT][NEUTRAL] What is the date again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And we're still in [PII], correct? Under [PII].
[CUSTOMER][NEUTRAL] Yeah, this is all hers. She got struck by lightning and it was a long process.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] Thankfully, she's OK.
[AGENT][NEUTRAL] Yes. All right. So I don't have any claims for [PII].
[CUSTOMER][NEUTRAL] You do not
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Wow, I, I don't understand. OK, I guess we're gonna get these years later, um, OK, then.
[CUSTOMER][NEUTRAL] OK, has not.
[CUSTOMER][NEUTRAL] Gone through APL.
[CUSTOMER][NEUTRAL] And then,
[CUSTOMER][NEUTRAL] Just 31.
[CUSTOMER][NEUTRAL] Um, this one is Miami-Dade Ambulance, another ambulance service, um, from what's the date?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Oh, this is [PII].
[CUSTOMER][NEUTRAL] [PII]. The other one was [PII]. This is West Kendall Baptist Hospital or Miami-Dade Ambulance Service. I'm not sure which would be billed under.
[AGENT][NEUTRAL] Maybe this one.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alr[PII]
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And this is 375 for this one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm waiting on the EOB on the document to pull up.
[CUSTOMER][POSITIVE] Perfect, no problem.
[AGENT][NEUTRAL] OK. Well we fully pay that one from Miami Day Ambulance.
[CUSTOMER][NEUTRAL] I'm sorry, say it again.
[AGENT][NEUTRAL] We fully pay that one.
[CUSTOMER][POSITIVE] Oh perfect, so that one's been paid um.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Paid by APL and that was 375.
[AGENT][NEUTRAL] Mhm. Yes, on [PII].
[CUSTOMER][POSITIVE] Thank you. And the check number?
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] If you don't mind.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Perfect. OK, so we paid 2, and then there's one more. I don't have the exact amount. I know it's $8000 but you said there was nothing for $831. Was there anything for 91 for $8000 because um my daughter took that bill. I should have taken a copy of that.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] It was that would have been.
[AGENT][NEUTRAL] You said 91.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, 91 that would have been in um.
[CUSTOMER][NEUTRAL] At Green in [PII], uh, that was at the, I don't know what hospital, that was probably Patewood Hospital.
[AGENT][NEUTRAL] No, I don't see nothing that large.
[CUSTOMER][NEUTRAL] Nothing for 91. OK, so then what you, you tell me if I'm doing the right thing. I need to call these companies and make sure that they have processed it through you guys, is that correct? Those that have not processed it.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, they need to, uh, yeah, you need to check with them to see if they have submitted the claim, and they have, if they have received anything from us, which, um, more than likely they haven't because we have not received them. But yeah, you just need to verify and make sure they're sending it to the [PII] address or they are faxing it to the 1-800 number on the back of the card.
[CUSTOMER][NEUTRAL] Submitted the
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And Ms. [PII], um, for future, you can always um register online and get the claim history if you would like to do that in the future, you can.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you'll be able to check everybody.
[CUSTOMER][NEUTRAL] OK, is that with the
[CUSTOMER][NEUTRAL] The app or um or do you have to you can just go on on your website.
[AGENT][NEUTRAL] It's just a website. It's just um [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and you can click on sign in and register. um, Mr. [PII] will have to register because it's gonna be his information.
[AGENT][NEUTRAL] But once he's registered, if he gives you permission to go in, you can view all the claims we have processed for each one of the members in the family.
[CUSTOMER][NEGATIVE] OK, perfect. Alright, um, so do you think, what is your, I mean, do I need to go through this is the issue I'm having. I when I call they don't answer and so I'll be on hold for 45 minutes to an hour and I get nowhere. So should I just wait for the paper bills?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And then and and see if if they've done because I most of these I've called and given the APL information but they're just I guess dragging their feet they're taking their time whatever um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I mean, is it worth my time?
[AGENT][NEUTRAL] OK, Miss [PII] mhm.
[AGENT][NEUTRAL] Yeah, I understand. The other option you have is submitting your own claims. Um, now, by submitting your own claims, we need 3 documents for each claim. Well, basically 2 documents for each uh each claim, but we need an extra document for all the claims. Um, so basically we're gonna need the claim form, our claim form that you can find in our website at [PII].
[AGENT][NEUTRAL] So you will go to [PII] and you will click on claims and forms and you will look for the Metlink claim form.
[CUSTOMER][NEUTRAL] Metlink.
[AGENT][NEUTRAL] [PII], which is the same name on the card, Medlink on the card.
[CUSTOMER][NEUTRAL] Madeline.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK, um, but then, so, mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, yeah, that seems like a lot of work where I'm just like, let them do the work. I mean, I'm not crazy about paying the bills, but.
[CUSTOMER][NEUTRAL] You know, so I guess I'll just let them do the work. They're eventually gonna come after me. I mean, they're eventually gonna want their money at some point, I assume.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm. Mhm.
[CUSTOMER][POSITIVE] So, all right, OK, well, that helps me a lot for today. Thank you so much for your help. I really appreciate it.
[AGENT][NEUTRAL] You're welcome, Miss [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] Thank you, thank you for calling ATL. Have a good afternoon.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you. Good.